The Best Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Both OTC and prescribed NSAIDs help to reduce pain and swelling

Many people are prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for a variety of common conditions, like arthritis, tendonitis, and bursitis. NSAIDs are useful because they help decrease pain, control swelling, and reduce inflammation.

However, anti-inflammatory medicine comes with both benefits and risks and benefits. This article discusses the pros and cons of prescription and over-the-counter NSAIDs and alternatives to anti-inflammatory drugs.

What Does Anti-Inflammatory Mean?

Anti-inflammatory refers to the ability of a medicine to help fight pain and unwanted or abnormal immune system reactions by reducing inflammation.

Prescription vs. OTC NSAIDs

NSAIDs are available both over-the-counter (OTC) and as a prescription medication. It's very important to understand that while there are differences between prescription and non-prescription anti-inflammatory drugs, this difference is not the potential relief of symptoms.

Many patients find their best response from over-the-counter NSAIDs. However, no studies have proven that newer NSAIDs (the so-called COX-2 inhibitors), prescription NSAIDs, or more expensive NSAIDs treat pain or swelling any better than more traditional NSAID medications. Most of the research evaluating the effects of NSAIDs has been done using over-the-counter ibuprofen.

Which NSAID Is Best?

Often patients will experience a different response in treatment with a different medication. This could be why some medications have helped your symptoms while others do not have a significant effect. This is not unusual, and it is difficult to predict which medications will most benefit a given individual.

The best way to determine which NSAID is best for you is to try different options. Often a healthcare provider will recommend one NSAID, and if adequate relief of symptoms is not obtained within several weeks of treatment, another NSAID can be tried.

One of the best reasons to consider some of the newer, prescription medications, such as Celebrex or Mobic, is that these may be taken as once-a-day doses rather than three or four times daily. In addition, the COX-2 inhibitors are thought to have fewer side-effects on the stomach.

While both over-the-counter and prescription NSAIDS help with pain, the stronger prescription NSAIDS are more likely to help inflammation.

Most Common NSAIDs

Names of medications can be confusing. Healthcare professionals often use generic and brand names interchangeably. The most commonly prescribed NSAID medications are:

  • Aspirin (Bayer, Ecotrin, Bufferin)
  • Ibuprofen (Motrin, Advil)
  • Naproxen (Aleve, Naprosyn)
  • Meloxicam (Mobic)
  • Celecoxib (Celebrex)
  • Indomethacin (Indocin)

Additional Treatment Options for Inflammation

Medicine isn't the only way to control inflammation and discomfort. As we become increasingly aware of and sensitive to the possible side-effects of any medication, more patients and healthcare providers alike are interested in non-pharmacologic methods to control inflammation.

There are many ways that people address inflammation. Some have better scientific support than others, but almost all are safe to try.

A good place to start is with the R.I.C.E. treatment, which stands for:

  • Rest
  • Ice
  • Compression
  • Elevation

Other treatments that may be helpful include the foods and supplements you ingest, topical treatments to the painful area, and the activities we perform.

An often-neglected method to control inflammation is rest. Not only does this mean resting from athletics, but often this means allowing an injured body part to rest from normal activities which may prolong inflammation.

Busy lives may not allow for rest, but ignoring the signs of inflammation may prolong the problem. Therefore, look for ways to rest your injured body part to allow the inflammation to subside and the recovery process to unfold.

Side Effects of NSAIDs

Side Effects of Nonsteroidal Anti-Inflammatory Medications

Verywell / Jessica Olah

NSAID medications have potential side effects, even though many of these medications can be obtained over-the-counter. Some of the side effects are minor, others certainly worrisome.

Some people may be more prone to side effects given other medical conditions. For that reason, NSAID medication should be used with caution. If there is ever a question of whether or not it is safe for you to take these medications, and you should discuss this with your healthcare provider.

Anyone taking NSAID medications for more than a few days should have a discussion with her healthcare provider about the potential for side effects.

Some of the more common side effects of NSAID medications include:

  • Stomach upset/ulcers: Some people are prone to gastrointestinal upset and the development of stomach ulcers as a result of taking these medications. People with a history of stomach ulcers need to use NSAID medications with extreme caution and always under the supervision of their healthcare provider.
  • Hypertension/stroke: The use of NSAID medications, especially for routine, longer-term use, has been shown to increase the risk of hypertension and stroke. People who have increased risk of these conditions should discuss NSAID use with their healthcare provider.
  • Bleeding risk: Certain NSAID medications can cause an increased risk of bleeding. This is particularly true for aspirin. Most people can tolerate this, but people who have upcoming surgical procedures or are on other blood-thinning medications may not be able to take NSAID medications.
  • Kidney problems: People with underlying kidney conditions may not be able to take NSAID medications, even in very low doses for a short time. 

While these are not the only risks associated with anti-inflammatory meds, they are somewhat more common, and some of the more worrisome, side effects. It is always safest to have a discussion with your healthcare provider if you have any concerns about the risk of taking these medications.

It is important to understand that even in healthy people without underlying medical conditions, there is always the risk associated with any medication. The benefits of taking an anti-inflammatory medication need to be balanced with the possible risks of taking the medication.

A Word From Verywell

Nonsteroidal anti-inflammatory medications are one of the most commonly used types of medications for musculoskeletal conditions. NSAIDs can be effective for a wide variety of orthopedic conditions from arthritis, tendinitis, or other inflammatory conditions.

Determining the best anti-inflammatory drug for your condition may depend on a number of different factors, and what works well for one individual may not be the best medication for another. There are possible side effects of different NSAID medications the patient should be aware of, and you should discuss with your healthcare provider if taking these medications for more than a short period of time.

Frequently Asked Questions

  • Is ibuprofen or naproxen better for inflammation?

    There isn't much head-to-head research comparing the two. One older study found that both were effective for relieving the symptoms of knee arthritis, but naproxen helped with more symptoms, such as night pain. In general, ibuprofen takes effect and wears off more quickly, while naproxen has a slower onset but lasts longer.

  • Can I take ibuprofen and naproxen together?

    No. Ibuprofen and naproxen are both NSAIDs. Taking more than one NSAID at a time is not recommended because it can increase the risk of adverse effects like stomach issues.

  • What is the strongest anti-inflammatory medication?

    Research shows diclofenac is the strongest and most effective non-steroidal anti-inflammatory medicine available. Diclofenec is sold under the prescription brand names Cambia, Cataflam, Zipsor, and Zorvolex. It is also available as a topical gel, Voltaren, which is available over the counter.

  • What are the signs of inflammation?

    Inflammation is the body’s immune response to an injury or illness. Acute inflammation causes redness, swelling, heat, pain, and loss of function in the area that is inflamed. 

  • How can I reduce inflammation quickly?

    Follow the RICE formula for inflammation due to an acute injury—rest, ice, compression, and elevation. For systemic inflammation, following an anti-inflammatory diet can help in the long term.

    NSAIDs and corticosteroids are often recommended for fast relief of pain and inflammation.

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11 Sources
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